Objective To explore the effectiveness of the generative large language model MedGo in nursing decision-making for elderly patients with multimorbidity. Methods A quasi-randomized controlled trial study was conducted involving 6 junior nurses, 6 senior nurses and the MedGo model from January 1, 2025 to March 31, 2025 at the Emergency Internal Medicine Ward of Shanghai East Hospital Affiliated to Tongji University. Clinical data of 120 elderly patients with multimorbidity were analyzed to compare the performance of the three groups in four tasks (nursing diagnosis assessment, nursing intervention formulation, complication identification, and complication prevention) from three evaluation dimensions: decision-making time consumption, decision accuracy, and decision-making quality. Results In terms of decision-making time, the senior nurse group completed all four tasks faster than the junior nurse group (P＜0.01), and the MedGo group completed all four tasks faster than the junior nurse group (P＜0.001) and the senior nurse group (P＜0.001). In terms of decision-making accuracy, senior nurse group scored higher than junior nurse group in all four tasks (P＜0.001), while the MedGo group outperformed the senior nurse group only in complication identification (P＜0.001). In terms of decision-making quality, the MedGo group scored higher than junior nurse group (P＜0.001) and senior nurse group (P＜0.001) in all four tasks. Conclusions The MedGo model demonstrates advantages of high efficiency, accuracy, and quality in nursing decision-making for elderly patients with multimorbidity; senior nurses outperform junior nurses in decision-making, providing diverse references for clinical nursing decision-making.

Objective:To evaluate the clinical efficacy of pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade in the management of optic disc pit maculopathy (ODP-M).Methods:A retrospective case analysis. From 2002 to 2021, 16 patients (16 eyes) diagnosed with ODP-M at Department of Ophthalmology of Peking University Third Hospital and Eye Center of Peking University People's Hospital were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, color fundus photography and optical coherence tomography (OCT) examinations. BCVA assessment was conducted using a standard logarithmic visual acuity chart, and during statistics, it was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity. According to the treatment methods, the affected eyes were divided into the laser treatment group and the surgical treatment group, with 2 and 14 eyes respectively. The affected eyes in the laser treatment group were only given simple laser photocoagulation treatment. All the affected eyes in the surgical treatment group underwent PPV combined with internal limiting membrane peeling and vitreous cavity filling with 16% SF 6. Among them, autologous platelet concentrate (APC) was simultaneously used in 5 eyes. The follow-up period after the operation was 13.5 (3-138) months. The differences in the absorption of subretinal fluid (SRF) and the improvement of BCVA in the macular area between the two groups of affected eyes were compared and observed. The absorption of SRF in the macular area measured by OCT was used as the criterion for judging the effectiveness of treatment. The Mann-Whitney U test was used for comparison between the two groups. Results:In the surgical treatment group, SRF in the macular area was completely absorbed in 14 eyes, and the complete absorption time was 7.0 (2-23) months. In the laser treatment group, SRF was not absorbed in both eyes. The logMAR BCVA of the surgical treatment group before and after the operation was 0.7 (0.3-2.0) and 0.4 (0.1-1.3), and the difference was statistically significant ( Z=2.809, P=0.005). The logMAR BCVA before and after the operation of the eyes with combined APC filling and those without combined APC filling were 0.6 (0.3-1.0) and 0.5 (0.1-0.7), as well as 0.7 (0.3-2.0) and 0.4 (0.2-1.3), respectively. There was no statistically significant difference in logMAR BCVA between the two after surgery ( Z=0.609, P=0.543). Conclusions:PPV combined with internal limiting membrane peeling and gas tamponade can effectively promote the absorption of SRF in the macular area of eyes with ODP-M, achieve anatomical macular restoration, and improve BCVA. Combined APC filling

Objective:To evaluate the clinical efficacy of pars plana vitrectomy (PPV) with internal limiting membrane peeling and gas tamponade in the management of optic disc pit maculopathy (ODP-M).Methods:A retrospective case analysis. From 2002 to 2021, 16 patients (16 eyes) diagnosed with ODP-M at Department of Ophthalmology of Peking University Third Hospital and Eye Center of Peking University People's Hospital were included in the study. All affected eyes underwent best corrected visual acuity (BCVA), intraocular pressure, color fundus photography and optical coherence tomography (OCT) examinations. BCVA assessment was conducted using a standard logarithmic visual acuity chart, and during statistics, it was converted to the logarithmic minimum angle of resolution (logMAR) visual acuity. According to the treatment methods, the affected eyes were divided into the laser treatment group and the surgical treatment group, with 2 and 14 eyes respectively. The affected eyes in the laser treatment group were only given simple laser photocoagulation treatment. All the affected eyes in the surgical treatment group underwent PPV combined with internal limiting membrane peeling and vitreous cavity filling with 16% SF 6. Among them, autologous platelet concentrate (APC) was simultaneously used in 5 eyes. The follow-up period after the operation was 13.5 (3-138) months. The differences in the absorption of subretinal fluid (SRF) and the improvement of BCVA in the macular area between the two groups of affected eyes were compared and observed. The absorption of SRF in the macular area measured by OCT was used as the criterion for judging the effectiveness of treatment. The Mann-Whitney U test was used for comparison between the two groups. Results:In the surgical treatment group, SRF in the macular area was completely absorbed in 14 eyes, and the complete absorption time was 7.0 (2-23) months. In the laser treatment group, SRF was not absorbed in both eyes. The logMAR BCVA of the surgical treatment group before and after the operation was 0.7 (0.3-2.0) and 0.4 (0.1-1.3), and the difference was statistically significant ( Z=2.809, P=0.005). The logMAR BCVA before and after the operation of the eyes with combined APC filling and those without combined APC filling were 0.6 (0.3-1.0) and 0.5 (0.1-0.7), as well as 0.7 (0.3-2.0) and 0.4 (0.2-1.3), respectively. There was no statistically significant difference in logMAR BCVA between the two after surgery ( Z=0.609, P=0.543). Conclusions:PPV combined with internal limiting membrane peeling and gas tamponade can effectively promote the absorption of SRF in the macular area of eyes with ODP-M, achieve anatomical macular restoration, and improve BCVA. Combined APC filling

Background N-nitrosamines, a group of by-products of drinking water disinfection, have strong cytotoxicity to mammals. N-nitrosamines in drinking water are at the ng·L⁻¹ level, and its accurate qualitative and quantitative analysis is difficult, so it is necessary to develop a sensitive and accurate method to determine N-nitrosamines in drinking water. Objective To establish a solid phase extraction-gas chromatography tandem mass spectrometry (GC-MS/MS) method for simultaneous determination of 10 kinds of N-nitrosamines in drinking water. To apply the established method to determine the levels of 10 kinds of N-nitrosamines in drinking water in Nanjing, and to understand the pollution status. Methods Coconut charcoal solid phase extraction (SPE) cartridge and HLB Pro SPE cartridge were compared for the extraction efficiency of 10 N-nitrosamines in drinking water. A coconut charcoal SPE cartridge and a HLB Pro SPE cartridge were concatenated using a SPE connector, and then formed two combinations: coconut charcoal (top)-HLB Pro (bottom) and HLB Pro (top)-coconut charcoal (bottom), to extract the spiked samples, and combined with direct and independent elution ways to obtain the best extraction efficiency. From November to December 2021, 9 raw water, 10 finished water, and 7 tap water samples were collected from 9 municipal water supply units in Nanjing with 1 L brown glass sampling bottles. An 1.0 L drinking water sample was added with the isotope internal standard to prepare a test sample containing an isotope internal standard concentration of 25 ng·L⁻¹. The automatic SPE instrument loaded all the 1.0 L drinking water samples to the tandem SPE cartridge of the HLB Pro (top)-coconut charcoal (bottom) at the rate of 15 mL·min⁻¹. After extraction, the HLB Pro SPE cartridge and coconut charcoal SPE cartridge were transferred to the solid phase extraction vacuum device and eluted with 10 mL of dichloromethane respectively, then the dichloromethane eluents were combined, and concentrated to about 1.0 mL by nitrogen blowing after a small amount of the upper aqueous phase was removed. The concentrated solution was detected by GC-MS/MS and quantified by isotope internal standard method. Results The comparison of sample spike recovery experiments showed that coconut charcoal solid phase extraction (SPE) cartridge and HLB Pro SPE cartridge presented highcomplementarity for the extraction efficiency of 10 N-nitrosamines in drinking water. Using HLB Pro (top)-coconut charcoal (bottom), independent elution, and combined with eluents, the optimal extraction efficiency was obtained. Under these conditions, by GC MS/MS, the 10 N-nitrosamines showed a good linear relationship within the range of 2–50 ng·L⁻¹, the correlation coefficients were all greater than 0.9996, the method detection limit was 0.149–0.211 ng·L⁻¹, and the limit of quantification was 0.596–0.844 ng·L⁻¹. At the spiked concentrations of 5.0, 15, and 30 ng·L⁻¹, the average recoveries of the 10 kinds of N-nitrosamines were 88.0%–104.8%, and the relative standard deviations were 1.22%–4.87%. When applying the method to determine the concentrations of the 10 N-nitrosamines in Nanjing drinking water, the results showed that the 10 N-nitrosamines were positive in different degrees in raw water, finish water, and terminal water, the detection rates were 0%–100%, and the concentrations were ND–27.6 ng·L⁻¹. Conclusion This tandem solid phase extraction-gas chromatography tandem mass spectrometry method can achieve simultaneous determination of a variety of N-nitrosamines in drinking water with high sensitivity and high throughput.

Objective? To investigate and analyze the nursing service demand and satisfaction of the operation patients in department of general surgery outpatient. Methods? A total of 516 operation patients were selected from the outpatient surgery in Eastern Hospital Affiliated to Tongji University from July to December 2017 were selected by convenience sampling method. Nursing service demand questionnaire and satisfaction questionnaire were applied in the investigation. Results? The average score of demand for nursing services of 516 patients was (3.72±0.62), which was between need and general. The highest requirement before operation was to know the time of the operation and the time needed for the operation. The highest requirement during operation was that I would not feel pain and discomfort. The highest requirement after operation was to tell me how to seek help if I got home uncomfortable. The average score of nursing satisfaction was (4.04±0.48), which was between great satisfaction and satisfaction. The most unsatisfactory thing for patients is that the waiting time is more than 30 minutes. There were significant differences in the needs of pre-operative, intraoperative and post-operative nursing services among patients of different ages (P＜0.05). Conclusions? There are many demands for nursing services in outpatients in department of general surgery. Operating rooms should cooperate with multiple departments to provide targeted nursing services to meet the needs of patients. Hospitals should constantly optimize the process of patients' medical treatment, adopt the method of time-division appointment, shorten the waiting time of patients, and improve patients' satisfaction.

Objective To observe the clinical effect of auricular bean-burying therapy in acupoints for patients with hepatocellular carcinoma after interventional therapy.Methods A total of 48 patients with hepatocellular carcinoma were divided into control group and observation group.The control group received western conventional nursing.The observation group applied auricular seeds.Pain scores and sleep quality were compared between two groups.Results The intervention group had lower painscores and quality of sleep at 2,3 and 7 d after intervention had lower than the control group (P ＜ 0.05).Conclusion Auricular bean-burying therapy in acupoints can effectively improve postoperative pain,and improve sleep quality for patients with hepatocellular carcinoma after interventional therapy.

Objective To observe the clinical effect of auricular bean-burying therapy in acupoints for patients with hepatocellular carcinoma after interventional therapy.Methods A total of 48 patients with hepatocellular carcinoma were divided into control group and observation group.The control group received western conventional nursing.The observation group applied auricular seeds.Pain scores and sleep quality were compared between two groups.Results The intervention group had lower painscores and quality of sleep at 2,3 and 7 d after intervention had lower than the control group (P ＜ 0.05).Conclusion Auricular bean-burying therapy in acupoints can effectively improve postoperative pain,and improve sleep quality for patients with hepatocellular carcinoma after interventional therapy.

Objective To explore the influence of the hospital-community integrated nursing on PICC management of tumor patients undergoing chemotherapy. Methods A total of 126 patients were randomly divided into control group and experimental group on average from June 2013 to June 2014, and the patients of control group used routine care while the patients of experimental group adopted hospital-community integrated nursing. We compared the incidence of PICC complications and health status, in which health status assessed by SF-36. Results After implementation of hospital-community integrated nursing, the incidence of durative staxis, infection and phlebitis in the experimental group were lower than those of the control group, and the total complication incidences (11. 11%) were lower than 53. 97% of the control group (P<0. 05). Each scores of health status items in the experimental group was better than that of the control group as well (P <0. 05). Conclusions The hospital-community integrated nursing can increase the nursing quality of community hospital and the quality of life of patients, and play a positive role on integrating medical resources and protect the benefits of patients.

Spinal cord injury and regeneration involves transcriptional activity of many genes, of which many remain unknown. Using the rat spinal cord full- transection model, bioinformatics, cloning, expression assays, fusion proteins, and transfection techniques, we identified and characterized one such differentially expressed gene, termed scirr1 (spinal cord injury and/or regeneration related gene 1). Fourteen orthologs were found in 13 species from echinoderm to insect and human by Blast search of NCBI protein reference sequence database. However, no further information is available for these homologues. Using whole-mount in situ hybridization, mouse scirr1 mRNA was expressed temporally and spatially in accordance with the early development sequence of the central nervous system. In adult rat spinal cord, expression of scirr1 mRNA was localized to neurons of gray matter by in situ hybridization. Using immunohistochemistry, SCIRR1 protein was found to be up-regulated and expressed more highly in spinal cord neurons farther from the epicenter of injury. Although the precise function of SCIRR1 is unknown, its unique pattern of expression during CNS early development and up-regulation after spinal cord injury suggest that SCIRR1 should be involved in the succeeding injury and/or repair processes of the injured spinal cord. Also, the typical F-box and leucine-rich repeat (LRR) architecture of rat SCIRR1 indicated that it may play an important substrate recruiting role in the pleiotropic ubiquitin/proteasome pathway. All these make scirr1 a new interesting start to study the spinal cord injury and regeneration mechanism.
Amino Acid Sequence ; Animals ; Base Sequence ; Brain/embryology/metabolism ; Embryo, Mammalian/metabolism ; F-Box Proteins/*biosynthesis ; Gene Expression Regulation, Developmental ; Male ; Mice ; Molecular Sequence Data ; Organ Specificity ; PC12 Cells ; Phylogeny ; Rats ; Rats, Wistar ; Spinal Cord/embryology/metabolism ; Spinal Cord Injuries/*metabolism ; Up-Regulation

Objective To investigate the involvement of apoptosis in the lesions of patients with psoriasis. Methods The apoptosis was detected with terminal deoxynucleotidyl transferase mediated dUTP biotin nick end labeling (TUNEL), and the expression of p53, PCNA and apoptosis suppressing protein bcl 2 was assessed with immunoperoxidase technique in psoriatic lesions and normal skin. Results A large number of keratinocytes showing biochemical and morphologic features of cells undergoing apoptosis were observed in all the suprabasal layers of the psoriatic epidermis. The plaques from all patients analysed showed marked increase in the number of PCNA positive cells in the middle and basal keratinocytes, and a dramatic reduction in the number of bcl 2 positive cells in the basal cell layer. Conclusion The increased apoptosis of keratinocytes in the lesions of psoriasis might be a homeostatic mechanism to the hyperplasia of cells.